Depressive symptoms among adults 18–69 years in Italy: results from the Italian behavioural risk factor surveillance system, 2007

Care pathways for people with major depressive disorder: a European Brain Council Value of Treatment study

Background

Despite well-established guidelines for managing major depressive disorder, its extensive disability burden persists. This Value of Treatment mission from the European Brain Council aimed to elucidate the nature and extent of “gaps” between best-practice and current-practice care, specifically to:Identify current treatment gaps along the care pathway and determine the extent of these gaps in comparison with the stepped-care model and Recommend policies intending to better meet patient needs (i.e., minimize treatment gaps).

Methods

After agreement upon a set of relevant treatment gaps, data pertaining to each gap were gathered and synthesized from several sources across six European countries. Subsequently, a modified Delphi approach was undertaken to attain consensus among an expert panel on proposed recommendations for minimizing treatment gaps.

Results

Four recommendations were made to increase the depression diagnosis rate (from ~50% episodes), aiming to both increase the number of patients seeking help, and the likelihood of a practitioner to correctly detect depression. These should reduce time to treatment (from ~1 to ~8 years after illness onset) and increase rates of treatment; nine further recommendations aimed to increase rates of treatment (from ~25 to ~50% of patients currently treated), mainly focused on targeting the best treatment to each patient. To improve follow-up after treatment initiation (from ~30 to ~65% followed up within 3 months), seven recommendations focused on increasing continuity of care. For those not responding, 10 recommendations focused on ensuring access to more specialist care (currently at rates of ~5–25% of patients).

Conclusions

The treatment gaps in depression care are substantial and concerning, from the proportion of people not entering care pathways to those stagnating in primary care with impairing and persistent illness. A wide range of recommendations can be made to enhance care throughout the pathway.

The costs of treatment resistant depression: evidence from a survey among Italian patients

INTRODUCTION

Treatment resistant depression (TRD) is a severe form of major depressive disorder associated with high symptoms severity, disability, and health resource utilization.

AIM

The purpose of this study is to estimate the coss of TRD in Italy.

METHODS

The study was carried on a sample of Italian patients diagnosed with TRD in 2019. In total, 306 observations were collected. The first step was to estimate the health and social costs of TRD resulting from the survey applying the Italian tariffs, daily wages, and prices. Secondly, we focused on the determinants of out of pocket expenditure (OOPE). A parametric analysis was performed to explore the association between the costs of TRD and a set of co-variates.

RESULTS

In total, the average healthcare costs were €2,653. A national average of 42 lost working days was estimated resulting in a total cost of €7,140 per patient. Regarding OOPE an average of € 615 per patient was found. Regression results showed how relevant regional gradients are likely to affect the amount of OOPE for TRD.

CONCLUSIONS

the study confirms the important burden of TRD in Italy with specific focus on out of pocket expenditure. High heterogeneity is shown concerning regional settings.

Migrant health in Italy: a better health status difficult to maintain-country of origin and assimilation effects studied from the Italian risk factor surveillance data

Background

Many studies on migrant health have focused on aspects of morbidity and mortality, but very few approach the relevant issues of migrants’ health considering behavioral risk factors. Previous studies have often been limited methodologically because of sample size or lack of information on migrant country of origin. Information about risk factors is fundamental to direct any intervention, particularly with regard to non-communicable diseases that are leading causes of death and disease. Thus, the main focus of our analysis is the influence of country of origin and the assimilation process.

Method

Utilizing a surveillance system that has been collecting over 30,000 interviews a year in Italy since 2008, we have studied migrants’ attitudes and behaviors by country of origin and by length of stay. Given 6 years of observation, we have obtained and analyzed 228,201 interviews of which over 9000 were migrants.

Results

While migrants overall present similar conditions to native-born Italians, major differences appear when country of origin or length of stay is considered. Subgroups of migrants present substantially different behaviors, some much better than native-born Italians, some worse. However, integration processes generally produce a convergence towards the behavioral prevalence observed for native-born Italians.

Conclusions

Health programs should consider the diversity of the growing migrant population: data and analyses are needed to support appropriate policies. Many migrants’ subgroups arrive with healthier behaviors than those of their adopted country. However, they are likely to have a less favorable social position in their destination countries that could lead to a change towards less healthy behaviors. Interventions capable of identifying this tendency could produce significant better health for this important part of the future (multicultural) populations.

Help-seeking behaviour for depressive disorders among adult cardiovascular outpatient cardiac clinic Jimma University Teaching Hospital, Jimma, South-West Ethiopia: crosssectional study

BACKGROUND

Depression in healthy person without cardiac disease has been associated with the development of coronary artery disease and cardiovascular disease also risk factor for development of depression. This has devastating effect the patient's quality of live, illness progression, morbidity and mortality. Despite this fact help seeking behavior of cardiovascular patients with depression has not been addressed in Ethiopia.

OBJECTIVE

To assess help-seeking behaviors of adult cardiovascular patients with depression for their depressive disorders in Jimma university teaching hospital.

METHOD

Institution based cross sectional study conducted October to December in 2014. The study was conducted on 353 cardiovascular patients who attended at cardiac clinic. Depression was assessed using patient health questionnaire version nine (PHQ-9), which is validated in Ethiopia, Help seeking behavior using actual help seeking questionnaire and social support using Oslo social support-3 item scale.

RESULT

From the total of 339 participants, 57.5% (n = 195) of them fulfill the case definition of depression and 12.1% (n = 41) of participant reported idea of hurting themselves. Only 33.3% sought help for their depression. Of those participants who sought help, 88.6% sought help from one or more of an informal help source. Occupation (odds of = 4.24, 95% confidence interval (CI) 1. 31, 13.78), education level (AOR 7.6, CI 2. 13, 27.11), the presence of a history of mental illness in the family (AOR 7.33, CI 2. 72, 19.80), ideal of hurting themselves, knowing the availability of the psychiatric service in this hospital and having previous seeking help were significantly associated with help seeking behavior.

CONCLUSION AND RECOMMENDATION

The number of patients not seeking help for depression is high. There for scaling up mental health service in tertiary hospitals through multidisciplinary approach should be given high priority.

Comparison of Health and Risk Factors of Older, Working-age Australians, Italians and Italian-born Migrants to Australia, with Data from an Italian (PASSI), and an Australian (SAMSS) Risk Factor Surveillance System

Italian-born migrants (post-WWII) are the largest non-English-speaking background migrant group in South Australia. A cross-sectional, inter-country comparison using independent samples (40–69 years of age) from two (one in Australia, one in Italy) similar risk factor and chronic disease surveillance systems. None of the three groups (Italians, Australian-born and Italian-born Australians) had definitively worse health although the Italians had high rates for four of the seven risk factors reported (current high blood pressure, current high cholesterol, current smoking, eating less than five fruit and/or vegetables per day) than Australian-born and Italian-born Australians. Italian-born Australians had higher rates for insufficient physical activity, overweight/obese, poor self-reported health and diabetes. Australian respondents were more likely to report having two or more drinks of alcohol per day. Issues facing an ageing population require appropriate health care needs and an assessment of structural or cultural barriers to health services.

Intensity and prevalence of depressive states in cancer inpatients: a large sample descriptive study

In cancer patients, depression causes suffering during the whole disease trajectory and it also influences the personal perception of well-being as well as treatment adherence. Consequently, its better definition is needed for planning more tailored supportive programmes. This study was aimed to provide information on depressive state intensity and prevalence in an heterogeneous sample of cancer inpatients. In addition, associations were studied between depressive state and different socio-demographic and clinical factors. A total of 1,147 consecutive adult cancer inpatients completed the Center for Epidemiologic Studies Scale on Depression together with a form for collecting socio-demographic and clinical data. The mean score of depression was 16.9 (SD = 9.3). There were differences in depression intensity associated with gender (p < .001), age (p = .001) and cancer type (p < .001), but not with education level (p = .282) or marital status (p = .436). Of the entire sample 13.9% had depressive states; this percentage raised to 26.2% if a less stringent criterion was used. These data reinforce the importance of a clinical and research focus on depression in oncology. As differences according to gender, age and diagnosis exist in depression prevalence and intensity, tailored supportive intervention should be planned and verified for effectiveness and efficacy.

Application of the varying coefficient model to the behaviour risk factor surveillance data in Italy: a study of changing smoking prevalence among sub-populations

Background

Behaviour risk factor surveillance (BRFS) data can be an important source of information for studying changes in various health outcomes and risk factors. Results obtained from surveillance data analysis are vital for informing health policy interventions, particularly with regards to evolutionary aspects. The objective of this analysis was to recommend a method that can be used for analysing trends in the association among variables from large public health data sets. This was demonstrated by examining the changing effects of various covariates, representing different sub-populations, on smoking status over time.

Methods

In our work, we propose the use of varying coefficient models (VCM) with non-parametric techniques to catch the dynamics of the evolutionary processes under study. This is a useful method, which allows coefficients to vary with time using smooth functions. Italian BRFS data from 2008-2012 was used with a sample size of 185,619 observations. In the application, a time VCM is fit for a smoking status binary outcome variable using the P-spline estimation method. The model includes ten independent variables comprising socio-demographic, health risk and behaviour variables.

Results

The VCM fit for the data indicates that the coefficients for some of the categories for the age and the alcohol consumption variables varied with time. The main results show that Italians aged 18-29 and 40-49 had higher odds of being smokers compared to those aged 60-69; however, these odds significantly decreased in the period 2008-2012. In addition, those who do not drink had lower odds for being a smoker compared to high risk drinkers and these odds decreased further during the observation period.

Conclusion

The application of the VCM to the BRFS data in Italy has shown that this method can be useful in detecting which sub-populations require interventions. Although the results have shown a decrease in the odds of being a smoker for certain age groups and non-drinkers, other sub-populations have not decreased their odds and health inequalities remain. This observation indicates that efforts and interventions are still required to target these non-changing sub-populations in order to modify their smoking behaviour.

Branch-type intraductal papillary mucinous neoplasm of the pancreas: clinically and patient-reported outcomes

OBJECTIVES

The majority of intraductal papillary mucinous neoplasms (IPMNs) of the pancreas are branch duct (BD) IPMNs, and these neoplasms are being diagnosed with increasing frequency; no data are also available on the well-being (quality of life [QoL]) of these patients. We aimed to evaluate the 2-year follow-up results in consecutive patients with BD-IPMNs to assess symptoms at presentation and their morphological progression; the physical and psychological statuses of these patients were also evaluated.

METHODS

One hundred one patients with BD-IPMN of the pancreas were enrolled in the study (37.6% men and 62.4% women; mean [SD] age, 66.3 [10.4] years). Magnetic resonance imaging was used to evaluate the modification of the cystic lesions at baseline as well as in the follow-up. The SF-12 Health Survey, the State-Trait Anxiety Inventory Y-1 and Y-2, the 12-Item General Health Questionnaire, as well as the Beck Depression Inventory-II were used to evaluate the QoL once a year.

RESULTS

The mean (SD) basal size of the major lesion was 15.5 (8.9) mm, and in the follow-up period, the size remained stable. The QoL did not change during the follow-up period.

CONCLUSIONS

Branch duct IPMNs are very slow-growing neoplasms, and they do not affect the QoL of affected patients.

Quality of life in patients with long-standing chronic non-pathological pancreatic hyperenzymemia

BACKGROUND

Chronic non-pathological pancreatic hyperenzymemia is a benign condition characterized by the persistent elevation of serum pancreatic enzymes without morphological alterations of the pancreas. No information is available regarding the quality of life of these subjects.

AIM

To evaluate the physical, mental and psychological status of these subjects using SF-12 Health Survey questionnaire and the 12-item General Health Questionnaire.

METHODS

Fifty-one consecutive subjects having long-standing chronic non-pathological pancreatic hyperenzymemia (duration: 11.0 years, range 5-21) were studied. The Italian version of the SF-12 questionnaire and the General Health Questionnaire were compiled by the subjects studied.

RESULTS

Regarding the SF-12 questionnaire, the physical component scores and the mental component scores were 50.1 ± 8.0 and 44.7 ± 11.7, respectively and these figures were not statistically different from those of reference Italian population. Regarding the psychological status, seven subjects (13.7%) had non-psychotic-psychiatric problems. No statistical differences in the physical component score, mental component score and general health questionnaire were found between patients having non-familial or familial chronic non-pathological pancreatic hyperenzymemia.

CONCLUSIONS

Subjects with long-standing chronic non-pathological pancreatic hyperenzymemia had a quality of life no different from that of the Italian population. The explanation provided by the physician regarding the benignity of long-standing chronic non-pathological pancreatic hyperenzymemia is enough to reassure this type of patient.

Social determinants effects from the Italian risk factor surveillance system PASSI

OBJECTIVES

To offer examples on how risk factor surveillance systems can help in providing useful information on social determinants effects and health inequalities.

METHODS

The Italian risk factor surveillance system (PASSI) collects monthly information from most of the Italian Local Health Units (over 85% of the Italian population is covered) on major health-related behaviours together with information on health practices, attitudes and opinions. Multivariate analysis of associations with possible indicators of social determinants collected by the system, offers important indications on the value that the system has in providing useful information on the effects of social determinants.

RESULTS

Social determinants, although measured through very simple indicators, have major influence on health outcomes (in the example here, depression), geographical disparities in health (efficacy of smoking ban), and access to preventive services (pap test in our analysis).

CONCLUSIONS

Risk factor surveillance can offer valuable information for monitoring social determinants effects and inequalities, and, when considering data over time, for evaluating the gross impact of future interventions and policies aimed at reducing them.